精神科住院病人舒适需求状况调查

目的了解精神科住院病人的舒适需求状况。方法参考住院病人舒适需求问卷,针对精神科病人特点适当修改后,采用修改后的问卷对心身病科及4个重度精神病科病情稳定病人进行舒适需求调查。结果心身病科和重度精神病科病人在刚入院时最想知道什么、希望护士主动介绍的疾病知识、最大的舒适护理要求、希望护士对病人最主要的关心等方面,需求差异有统汁学意义(P＜0．05或＜0．01)。结论心身病科及重度精神病科病人对舒适的需求存在差异,提示舒适护理应根据病人的不同需求提供,以提高病人的生活质量,并使病人早日康复,同时也是提高服务满意度的有效途径。     

住院病人对基础护理的感受与需求的质性研究

[目的]探究住院病人对基础护理的感受与需求。[方法]选取山西省汾阳医院的16例住院病人进行深度访谈,用Colaizzi法分析资料。[结果]共提炼4个主题:心理顾虑增加、身体感受存在差异、信息沟通结果不一、护理需求多样。[结论]护理人员应重视对住院病人感受与需求的评估,不断提高基础护理水平,将共情护理、信息支持融入护理操作,促进病人的舒适体验、满足身心需求。     

住院病人护理需求研究现状

为了解住院病人的护理需求特点,更好地提供满意的护理服务,对住院病人护理需求的研究现状进行了综述。住院病人需求多样化,需求范围广泛,疾病不同、住院阶段不同其需求的侧重点不同,住院病人的心理需求、健康教育需求较高,同时护士与病人对需求的认知存在差异,针对这些特点分别提出了相应的护理对策。     

不同人口学特征的住院病人护理需求调查

[目的]了解不同人口学特征住院病人护理需求.[方法]采用整群抽样,用自行设计的《住院病人护理需求调查表》对某三级甲等综合医院634例住院病人进行调查.[结果]不同年龄住院病人在生理需求、爱与归属需求上存在差异;不同婚姻状况、职业的住院病人在生理需求方面存在差异.不同性别、婚姻、年龄、职业、文化程度、经济收入的住院病人均在单项需求中存在差异.[结论]不同人口学特征的住院病人护理需求不同.护理人员应根据住院病人的不同人口学特征满足其不同的护理需求,提高病人满意度.     

不同人口学特征的住院病人护理需求调查

[目的]了解不同人口学特征住院病人护理需求。[方法]采用整群抽样,用自行设计的《住院病人护理需求调查表》对某三级甲等综合医院634例住院病人进行调查。[结果]不同年龄住院病人在生理需求、爱与归属需求上存在差异;不同婚姻状况、职业的住院病人在生理需求方面存在差异。不同性别、婚姻、年龄、职业、文化程度、经济收入的住院病人均在单项需求中存在差异。[结论]不同人口学特征的住院病人护理需求不同。护理人员应根据住院病人的不同人口学特征满足其不同的护理需求,提高病人满意度。     

不同人口学特征住院病人满意度的差异性研究

[目的]调查不同人口学特征住院病人满意度的差异.[方法]采用整群抽样,利用自行设计的〈住院病人护理需求调查表〉中的数字评估法,对某三级甲等综合性医院634例住院病人进行满意度调查,并进行统计分析.[结果]男女病人的满意度没有差异,而婚姻、年龄、自理程度、职业、入院次数不同的病人满意度存在差异.已婚病人的满意度高于未婚病人,青年组的满意度明显低于其他各组,完全自理的病人比部分自理的病人满意度高,自由职业者的满意度低.[结论]人口学特征不同住院病人的满意度存在差异.护理人员应根据住院病人的不同人口学特征,满足其不同的护理需求,实施个性化护理,更好地提供优质护理服务,提高病人满意度.     

无缝隙护理管理在妇产科中的应用效果

目的:探讨无缝隙护理管理在妇产科中的应用效果。方法:将120例妇产科病人按时间段分为研究组60例和对照组60例,两组病人均给予常规药物治疗,对照组给予常规护理,研究组在了解病人住院需求的基础上建立无缝隙护理管理运行模式,接受无缝隙护理服务。出院后,采用住院病人满意度和自行设计的住院病人心理舒适感问卷调查表进行效果评定。结果:出院时,两组病人心理舒适感评估,研究组安全感为95.0%、满足感为97.5%、尊重感100%,对照组安全感为81.7%、满足感为78.3%、尊重感83.3%。两组比较存在显著差异(P0.05,P0.01);两组病人满意度总体评比,研究组为(4.86±0.52)分,对照组为(4.43±0.49)分,两组比较,差异显著(P0.01)。结论:无缝隙护理管理模式能够提高护理工作质量和住院病人满意度。     

基于马斯洛基本需求理论为框架的住院病人需求调查

[目的]了解基于马斯洛基本需求理论为框架的住院病人需求,为护士提供针对性护理措施提供依据。[方法]以马斯洛基本需求理论为框架,制订住院病人需求项目调查表对200名住院病人进行住院病人需求情况调查。[结果]病人在住院期间需求较为强烈的19项护理需求和对医院工作的基本要求。[结论]护士应根据病人的不同护理需求及时调整护理行为,以为病人提供优质服务、让病人更加满意和放心。     

胸外科住院手术病人舒适护理需求调查与舒适护理措施

目的:了解胸外科住院手术病人舒适护理需求,制定舒适的护理措施。方法:采用我院自行设计的胸外科住院手术病人舒适护理需求调查表对130例胸外科住院手术病人术后4、24、48h舒适护理需求进行问卷调查。结果:病人舒适护理需求强烈的因素有:疼痛、管道不适、口渴、饥饿感、体位不适、睡眠障碍。心理不适和环境不适也应引起护理人员的注意。结论:护理人员针对胸外科术后病人舒适护理需求,采取切实可行的舒适护理措施,可提高病人的舒适度。     

住院病人对优质护理服务能力需求的调查研究

[目的]了解住院病人对优质护理服务能力的需求现状。[方法]采用自行设计的"住院病人对优质护理服务能力需求调查问卷"对124例住院病人进行调查。[结果]住院病人对优质护理服务能力需求的总分为134.07分±36.25分,其中健康指导能力、临床护理能力得分较高,自主学习能力得分较低;不同特征的病人对优质护理服务的需求不同(P<0.05)。[结论]针对病人的需求对护士进行相关能力的培训,以期提高病人的住院满意度。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.